Medication for Weight Loss

May 19, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Ironic, isn't it, Smithers. This anonymous clan of slack-jawed troglodytes has cost me the election, and yet if I were to have them killed, I would be the one to go to jail. That's democracy for you. The most disturbing part of that statement isn't the casual reference to executing one's political rivals. The most disturbing part is that line will never be said again by Harry Shearer. Harry Shearer is not coming back to the Simpsons for season #28. I don't think you understand the gravity of the situation. He has been with the show since 1989. He voices Mr. Burns, Ned Flanders, Waylon Smithers, Principal Skinner, Reverend Lovejoy, Kent Brockman, Dr. Hibbert, Lenny, Otto Mann, Rainier Wolfcastle and Dr. Marvin Monroe. These are dark days indeed. Most certainly not, Excellent.

These are dark days because Mr. Burns had so many uplifting and life affirming messages for the world. Such as, Family. Religion. Friendship. These are the three demons you must slay if you wish to succeed in business. And You're Actually pleased with your Appearance? My Boy You're the fattest thing I've ever seen, and I've been on safari! Okay, that last one hit close to home. But what would Mr. Burns do if he was in my shoes? He would invent a weight loss pill!

Mr. Burns would understand the inventor of a popular weight loss pill would become incredibly rich. Being evil, Mr. Burns would understand it wouldn't even have to work. A couple of years ago I was talking to a rep from one of our chemical suppliers for compounding. I asked him what was new and popular. He told me I should stock Green Coffee Beans. He said Dr. Oz mentioned them as the new thing for weight loss. He said they were flying off the shelves. Unfortunately, it seems the weight loss claims about Green Coffee Beans were grossly exaggerated and they are now considered ineffective.

Dr. Oz was even questioned about Green Coffee Beans in front of the US Congress, a group not known for their positive public image. Burns would know how to deal with Dr. Ozs bad press. When his assistant, Mr. Smithers said Public image is down sir. It seems the people view you as some kind of ogre. Mr Burns retorted: Well I ought to club them and eat their bones!

Until February, the only prescription medication approved for weight loss in Canada was orlistat or Xenical. Pharmacologically, orlistat is interesting because it blocks a percentage of the fat you eat from getting absorbed by your guts. That is both good and bad. The good is less fat absorbed means less calories for you to burn off. However, if you take an orlistat and then go eat a very greasy fast food meal, you will have a very upset stomach. You could have bloating, gas and oily loose stools. You could look at this as a biofeedback mechanism to encourage you not to eat fatty foods, though.

In February 2015, Health Canada approved liraglutide for weight loss under the brand name Saxenda. This was interesting since we have been dispensing liraglutide since 2010. Liraglutide is marketed as the brand name Victoza and is used to treat type 2 diabetes. Liraglutide is in a group of medications we call incretins. Incretins are hormones made in your gut. They are released when you eat food with carbohydrates in them. There are several naturally occurring incretins but liraglutide mimics Glucagon Like Peptide 1 (GLP-1). GLP-1 does some interesting things. It delays the emptying of the stomach, it makes beta cells in the pancreas produce more insulin, reduces glucagon secretion and it convinces your brain that you are less hungry. We have had experience with liraglutide in diabetics and some diabetics on it have lost weight. So Saxenda will be a once a day injection just like Victoza, but at a much higher dose. It will also be very expensive.

In the US there is another drug that is being repurposed for weight loss. It is called Vyvanse or lisdexamfetamine. It is a stimulant that is currently used to treat ADHD. It just got approval to treat binge eating disorder in the US. The theory goes like this. Researchers noticed many people with ADHD became overweight. The researchers felt it was because the ADHD patients couldn't follow a healthy meal plan and made impulsive food choices that were unhealthy. When the ADHD people were put on an appropriate medication that controlled their ADHD, they lost weight.

There are a couple of problems that may pop up if Vyvanse becomes approved to treat binge eating in Canada. The first is What is binge eating? I feel like I'm binging if I want 1 cookie, but I accidentally eat an extra 4 cookies. Eating disorder specialists say binging is really when you eat an extra 2 boxes of cookies. Apparently 20% of true binge eaters consume an extra 5000 calories in a binge, which is about 10 Big Macs. So most overweight people are not true binge eaters. That means there is a danger that Vyvanse will be over prescribed to overweight people who aren't actually binge eaters. The second danger is Vyvanse is as stimulant like amphetamine. We have been down this amphetamine road for weight loss before, with bad results.

When I had just started being a pharmacist back in 1997 there was a weight loss drug combination on the market called phen-fen. It was made up of phentermine and fenfluramine. Fenfluramine was closely related to the antidepressants the SSRI's. Phentermine was a stimulant like amphetamine. Phen-fen was pulled off the market because it caused heart valve problems. I think we should be careful before we start using stimulants for weight loss again.

Weight loss is complicated. An overweight patient will have to eat less and that is very difficult in our pre-packaged, fast food world. There do seem to be several weight loss pills that will be coming to market in the next couple of years to help. They all will be expensive. None of them seem to be anywhere near as effective for weight loss as bariatric surgery. And bariatric surgery is expensive and has significant risks as well. There seems to be no easy, quick fixes to obesity. What we really need is motivation to eat less and exercise more. What would Harry Shearer say at a moment like this? Smithers. Release the Hounds!

As always if you have any questions or concerns about these products, ask your pharmacist.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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